What Does Retirement in Singapore Look Like?

Every now and then, the mass media will run article and stories about preparing for retirement. This comes no great surprise, since Singapore is one of the fastest ageing countries in the world, with a quarter of the residents expected to be above the age of 65 by 2030. The most recent run of stories focuses on working and keeping busy post retirement age, and in fact, retiring the idea of retirement (see “Let’s Retire The Word Retirement” and “Redefining Retirement: 7 Considerations”). Interestingly enough, both articles cite a study on ageing done by the Centre of Ageing Research & Education at the Duke-NUS Medical School. This study, completed over 2016-17, was carried out by profiling more than 4,500 elderly Singaporeans, aged 60 and above across a wide range of dimensions. The complete report can be found here, and the follow-up research in 2019 here.

The key conclusion that the newspaper stories draw from this voluminous study is that we should not think of retirement as a change from working to not working, but rather we should seek to continue working and keeping busy. after all the studies cited above have found that retirees who have carried on working (about a quarter of them) are healthier, both physically and psychologically, than those who don’t. But a closer look at the results of the studies reveal that it could well be that those who are healthier choose to continue working, rather than working making them healthier, which is quite a different point of view. Furthermore, the wealth of information collated in these studies do reveal quite a different world retirees in Singapore live in compared to what we may think of. What does retirement in Singapore actually look like?

What does Retirement in Singapore look like?

Health is Wealth in Retirement

In a nutshell, life can be boiled down to a combination of time, wealth and health. We will be in a happy place if we have enough of all three to do the things we want, and live the lives we want. In general, the media inundates us with viewpoints on the wealth and time part for retirement. But what does the health part look like? Let’s see what health is really like for retirees in Singapore as revealed in the SIGNS Study I, focusing on:

Chronic illness
Acute illness
Disability
Healthcare

Chronic Illness in Retirement

Realistically, we should expect more and more chronic illnesses with increasing longevity. But even so, it may come as a surprise that amongst the elderly, less than 20% report not having any chronic illnesses at all. And this is not just something that afflicts the older retirees, as even amongst those aged 60-69, almost 80% of them report suffering from at least one chronic illness, with the number of chronic illnesses suffered increasing with age:

Percentage of Retirees Surveyed with Chronic Illnesses

	Overall	Age 60-69	Age 70-79	Age 80 & older
0 illnesses	17.8%	21.7%	14.9%	10.7%
1 illness	21.7%	24.7%	18.9%	16.8%
2 illnesses	22.9%	22.3%	23.9%	23.3%
3 or more	37.6%	31.3%	42.3%	49.3%

Source: SIGNS Study I

And what may these chronic illnesses be? A look at the study reveals the most common of these:

Common Chronic Illnesses Suffered

	Overall	Age 60-69	Age 70-79	Age 80 & older
High Blood Pressure	55.8%	47.6%	63.5%	67.8%
High Blood Cholesterol	49.2%	46.3%	51.4%	51.7%
Cataract	30.9%	19.4%	38.7%	53.4%
Joint Pain, Arthritis, Rheumatism	28.7%	25.4%	29.6%	37.8%
Diabetes	25.1%	23.3%	27.1%	26.9%

Source: SIGNS Study I

What’s interesting from this table is that certain chronic illnesses are acquired over time as we age, while others such as high blood cholesterol and diabetes seem to be acquired even before retirement, as the proportion of sufferers do not increase meaningfully as we age. And hence for these, prevention is better than cure!

Acute Illnesses

What about acute illnesses? While chronic illnesses are a reality of ageing, and all of us have to eventually figure out a way to live with them, acute illnesses can rob us of the little time we have left in retirement.

Percentage of Retirees Surveyed with Acute Illnesses

	Overall	Age 60-69	Age 70-79	Age 80 & Older
Heart Attack	7.4%	5.2%	9.7%	9.8%
Heart Failure	1.9%	1.3%	2.0%	3.5%
Cancer	4.9%	4.6%	5.5%	4.9%
Stroke	4.7%	3.1%	6.2%	7.3%
Renal Ailments	8.1%	6.2%	9.7%	11.5%
Respiratory Illness	5.2%	4.8%	5.1%	6.8%

Source: SIGNS Study I

At first sight, the results of the survey on acute illnesses shown above look a little odd, as it seems to indicate that the prevalence of such illnesses is quite low. Which goes against the statistics such as the lifetime likelihood of cancer being between 20% to 25%. And also the fact that cancer and heart diseases account for more than 50% of all deaths in Singapore.

But this makes more sense when we realise that the retirees being surveyed are the survivors of such acute illnesses. Which means that most of the elderly do not survive for long once they are diagnosed. For example, with the likelihood of cancer being around 20% to 25%, and with only 5% of the survey population answering “yes” to the cancer question, it may mean that 75% of older cancer sufferers do not survive for long. Health is not just wealth, but also time in retirement.

Disability amongst Retirees

Back in the day, Eldershield and subsequently Careshield Life was launched as a form of insurance targeted at disability, especially amongst the elderly. Research had indicated that a man has a 40% lifetime chance of being disabled, while a woman has a 60% chance. Disability, in this case meaning the inability to perform 3 or more Activities of Daily Life (ADLs). So how are retirees in Singapore coping with disability?

Percentage of Retirees With Disabilities

	Overall	Age 60-69	Age 70-79	Age 80 & Older
No ADL difficulty	90.7%	96.6%	91.8%	69.5%
1-2 ADL difficulty	4.4%	2.1%	4.5%	11.5%
3 & more ADL difficulty	4.9%	1.3%	3.7%	18.7%

Source: SIGNS Study I

At first glance it appears that disability is not really a big issue amongst retirees except for those aged 80 and older. So what’s the big concern with Careshield Life and the like? Again, the explanation may be the survival rate of those with disabilities. After all, research has shown that being disabled results in the shortening of life expectancy by 10 years or more. A 70 year old person being disabled is like a healthy person aged 80, with 3-5 years of life expectancy left. So what we may be looking at in the survey results are the survivors of disability, and the low numbers indicate that the survivorship rate is unfortunately quite low.

Healthcare for Retirees

Anyone who is a caregiver for someone elderly will realise that weekly or monthly schedules seem to revolve endlessly around visits to the doctor. How true is this for retirees in general? Well the results of the study do give some insight into this.

Percentage of Retirees having Medical Consultations in the Past 3 Months

	Overall	Age 60-69	Age 70-79	Age 80 & Older
Private GP	30.5%	30.6%	30.6%	29.9%
Polyclinic Doctor	42.1%	38.3%	46.5%	46.0%
Private Specialist	3.8%	3.6%	3.8%	4.0%
Specialist Outpatient Clinic	24.3%	22.7%	25.1%	27.7%

Source: SIGNS Study I

While there will inevitably be some degree of overlap between private and public medical consultations, if we assume this to be small, it appears that between 69% to 77% of the retirees will have to visit a GP at least once every 3 months. Also, between 26% to 31% of them will also visit a specialist practitioner. Given the wait times, and scheduling appointments, it is likely that each of these visits will take up to a day, and moreover will have to be done during the work week as well.

In short, the routine of the average retiree will have a considerable amount of time devoted to medical consultations, even excluding the inevitable bouts of hospitalisation.

Early Retirement

With the idea of attaining financial independence, and hence having the means to retire early, is getting more and more fashionable nowadays, we may be mistaken in thinking that early retirement is an exclusive preserve of the young. Nothing could be further from the reality of it!

Focusing exclusively on the younger age group, aged between 60-69 at the time of the study, we see that early retirement is in fact a norm amongst those retired!

Percentage of those aged 60-69 in work or in retirement

% in Full Time Employment	37.5%
% in Part Time Employment	16.2%
% never worked	3.2%
% who are Retired	43.1%
of which % Retired Early	~51%

Source: SIGNS Study I

Surprisingly, 51% of those who were retired in their 60’s claim to have retired early. The difference between them and our more modern version of early retirement is that most of them did not do so because they were financially secure. Rather, a look at the reasons offered reveals this:

Reasons for Early Retirement

Source: SIGNS Study I

The top two reasons for early retirement were to play the role of a caregiver for a family member (presumably parent), and because of ill health. Ill health, we have covered earlier, with almost 80% of those aged 60-69 having some form of chronic illness, and hence this would be a likely cause of early retirement, especially for the men.

What is more interesting is the group which takes on a caregiver role (especially the women). Assuming the people in this group were born before 1957 (to be aged 60 and above in 2017), and whose parents are roughly 20-25 years older than them, it is likely that they left their jobs in their 50’s to look after their parents who are in their late 70’s and 80’s.

But the generations to come will have parents who are older than them by some 30 to 35 years. Assuming these parents will still be growing old and frail in their late 70’s and 80’s, for the coming generations, the necessity of caregiving for parents will come when they are in their 40’s and 50’s! This means it is likely that for many, especially women, their so called golden years, both for their careers and retirement, will be spent juggling caregiving responsibilities as well. And this will be the case no matter how financially secure their parents are.

The Future of Retirement May Not Be As Rosy As Portrayed

The perception of retirement, especially early retirement, has been incessantly reshaped in recent years as a period where we can be free from the day-to-day grind of our working lives to live our best lives, the so called golden years. In fact, some even say that there is no difference between our working years and our retirement years, and we can choose to continue working if we want to for a fulfilling retirement!

But the old adage that health is wealth is never so true before as it is now. When we look at actual surveys of retirees in Singapore, the reality of their golden years can be quite different from what we are trying to convince ourselves of.

Health is definitely the biggest issue, with almost 80% of the younger retirees (aged 60-69) dealing with at least one chronic illness. Acute illness and disability is another concern, with low long term survival rates threatening to cut short the few years retirees have left.

And finally, the burden of caregiving for our parents is not going to go away, and may even come sooner than expected for many of us, leaving us with precious little time for our own retirements.